1174510119 NPI number — JERZY H CIOS M.D.

Table of content: JERZY H CIOS M.D. (NPI 1174510119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174510119 NPI number — JERZY H CIOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIOS
Provider First Name:
JERZY
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174510119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1248
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21741-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-938-2828
Provider Business Mailing Address Fax Number:
302-733-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11116 MEDICAL CAMPUS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21742-6710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-665-1717
Provider Business Practice Location Address Fax Number:
301-665-1810
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  D0061813 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: MD060913L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101136060 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810001267 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 405686800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00203575 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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